CBD and Chronic Pain

Hey there everybody, and welcome to this presentation on the impact of the cannabinoid CBD in the treatment of chronic pain and opioid reduction. I'm your host, Dr. Donnelly Snipes. Chronic pain affects 50 to 116 million Americans. That's a lot of people. A lot of people experience chronic pain. And in this we're only talking about chronic non cancer pain. When you add in cancer pain, cancer related pain, it goes way up. Chronic pain is the number one cause of insomnia, which is linked to depression, increased inflammation and reduced immunity. None of those things are things that you want to have. Pain can be caused by a variety of different factors. Inflammation, you know, there are a lot of different things that cause inflammation. You can get a bug bite that causes inflammation. You can get something like Lyme disease that causes system inflammation. You can have neurotransmitter imbalances that contribute to inflammation, specifically serotonin. When serotonin levels are low, inflammation levels tend to be higher. Studies often show that CBD's effects are mediated by the serotonin receptors and alterations in the endogenous opioid system. So when people take cbd, it increases serotonin, it increases those natural endogenous opioids and helps them feel better. Pain can also be caused by neurological dysfunction. It can be nerve pain. There are a lot of people who have nerve pain from inflamed nerves. It can also be caused by other neurological dysfunction where the brain thinks there's pain, where there's really not, like phantom pain after a an amputation. The take home is there's a lot of different reasons for pain and we don't have a great solution to addressing a lot of them. Unfortunately, opioids right now are tend to be the go to for a lot of people with chronic non cancerous pain. And opioids as we all know, have a whole lot of side effects and problems and in and of themselves. So what about cbd? Well, CBD as we've talked about in other videos, is believed to reduce the inflammatory response and provide pain relief in inflammatory conditions, including autoimmune conditions. Well, one of the main features of an autoimmune condition is inflammation and inflammation goes along with pain. So if we reduce inflammation in those autoimmune conditions, a lot of times we will help reduce pain. It also has been shown to reduce pain post operatively and in people with osteoarthritis. Cannabinoids activate T regulatory cells which make sure that the body doesn't attack itself. So in addition to reducing inflammation. It helps prevent that response where the body starts attacking itself. That is what happens in autoimmune conditions. Cannabidiol, or CBD is a cannabinoid that binds to mu and delta opioid receptors. So cannabidiol goes in and actually turns on those endogenous opioid receptors. Now we have, you know, you're born with endogenous opioids in your system. You call them endorphins, they're your natural painkillers. So turning on those receptors is not going to produce a high. You know, a lot of times, you know, some people can push it really hard when they run and they can trigger a quote runner's high from endorphins. But what we're talking about with cadabidiol is not something that is psychoactive. 53% of chronic pain patients, and in this study, it looked at 131 people, which is a pretty big number. And all of these people had been on opioids for greater than a year. Now, that is significant because when you're on opioids for an extended period of time, your internal pain management system, your endogenous opioid system basically turns off. It says, okay, you're taking all the opioids you need orally, so I don't need to do my job. So pain perception actually tends to be higher when people are not ingesting their opioids. So that's, that's, that's to say that these people had already developed some tolerance to opioids because they'd been on them for greater than a year. However, they 53% of them were able to reduce or eliminate their use of opioids, and 94% reported quality of life improvements within eight weeks after beginning to take CBD extract as part of their pain management regimen. Now, I've said it, I think in every video so far. I'm going to say it again. CBD is an inhibitor of cytochrome P450. So when you take CBD and opioids at the same time, it increases the levels of opioids in your blood and it can be life threatening. So you don't want a monkey with this. In these particular patients, obviously they were medically supervised and the doctors reduced the amount of opioids that they were taking so they didn't experience life threatening respiratory depression. CBD has also emerged as an alternative to nsaids, your ibuprofens and your naproxen and those sorts of things which act by inhibiting the COX1 or COX2 enzymes, which lead to gastrointestinal ulcers, bleeding, heart attack and stroke. So NSAIDs are, you know, kind of nasty things when you really get down in there and start digging into it. The nice thing about CBD is that in it doesn't inhibit the COX1 or COX2 enzymes, so it doesn't have any of those side effects even at pharmacologically relevant doses. So taking enough to actually reduce inflammation and provide pain relief does not impact those enzymes at all. So you don't have the risk of the ulcers and the stomach upset and heart attack and stroke in patients with fibromyalgia. In one study, CBD treatment decreased pain by more than 30%, which was significantly greater than what the patients who were on place placebo experienced. So that's another good study that used a placebo. In studies of generalized chronic pain, CBD treatment did not significantly reduce measures of pain. So certain types of pain might not be as significantly impacted by cbd. However, there was consistent improvement in patient reported quality of life and quality of sleep. So what would be interesting is to examine what's different about the pain that responds to CBD and about the pain that doesn't. And finally, transdermal application or skin based application of CBD oil can achieve significant improvement in pain and other disturbing sensations in patients with peripheral neuropathy. Now, the most common condition in which patients have peripheral neuropathy is diabetes, for example. So transdermal application or topical application of CBD oil was actually found to help reduce the, the burning and this tingling and sensations that they experienced in their, in their fingers and their feet. And that's another excellent use for CBD in instead of something like, you know, well, other prescription medications, I won't call them all out. Additionally, it's not going to have the gastric issues, it's not going to have the other issues that you might see with certain other medications. I hope that gave you an idea about some of the things that CBD can do for people with chronic pain. Again, we're still really just now starting to learn about it. A lot of the research has been done on mice, not on humans, with the exception of those few studies that I cited. And a lot of the research has been done with a combination of CBD and thc. So I am eagerly looking forward to seeing more studies of th. I'm sorry of CBD alone to see the effectiveness of this particular cannabinoid in the treatment of anxiety, depression and chronic pain. In the next video, we will talk about CBD and smoking cessation. I'm your host, Dr. Donnelly Snipes.